HomeMy WebLinkAbout480 W Airport Blvd (5)?,0%4U
CITY OF SANFORD PER, APPLICATION
Permit #
Job Address: f --
Description of Work:
f �Q
V
Historic District: U Q
Permit Type: Building Electrical
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential _
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Date:
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Mechanical Plumbing Fire Sprinkler/Alarm Pool
_ Addition/Alteration Change of Service Temporary Pole _
Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Industrial
Plumbing Repair - Residential or Commercial
Construction Type: N of Stories: # of Dwelling Units: \x Flood Zone: (FEM�A,rff�orm required)
Owners Name & Address: �K-j
Phone:
Contractor Name & Address:
L1 -4-01K CA(, L44 =(+-'I )M.) 1 U c� (O State License Number: Veli n )QZ�L -1
Phone & Fax: 552- 3152-, '175 Contact Person: A, i cls Phone:
Bonding Company:,L'�
Address: ,tom
Mortgage Lender:/ t-+
Address:
Arcbitect(Engineer: Phone:
Address:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of
this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of tis verification will notify a owner of the �te
rty of the requirementsAlor'�Lien ;FS3.
GSignature of 0wna/AgentaSignature of Contractor/Agent mate
Daniel B. French -
Print = N%7 /� Prin • ontractorent's are
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Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
EUDA R. CERNO
MY COMMISSION EXPIRES
/ June 22, 2006
(IFIL: FD:
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LISA D WITTSTRUCK
comma DDO"9077
Expirr s 71IM009 S ,
B'�°d hru (00o1,DZ.4
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